Tensionable knotless anchors and methods of tissue repair

Abstract

Surgical devices and methods of soft tissue repair using pre-looped tensionable and non-pre-looped tensionable knotless fixation devices. A flexible material (for example, suture or suture tape) may be attached to the fixation device. A flexible material may be threaded through an eyelet of a tip provided as part of a swivel anchor assembly to provide added stability to the fixation devices.

What is claimed is: 
     
       1. A method of knotless tissue repair, comprising the steps of:
 providing a first fixation device with a first tensionable construct that has a tensionable loop; 
 providing a second fixation device with a non pre looped second tensionable construct; 
 anchoring the first and second fixation devices in bone such that the first and second fixation devices are arranged in a medial row; 
 passing the first tensionable construct of the first fixation device and the second tensionable construct of the second fixation device through tissue; 
 threading a free end of a flexible strand of the second tensionable construct through the tensionable loop of the first tensionable construct and then subsequently threading the free end of the second tensionable construct through an eyelet of a passing device coupled with the flexible strand of the second tensionable construct; 
 pulling on a tail end of the passing device opposite the eyelet thereof to thread the free end of the flexible strand of the second tensionable construct through a splice in the second tensionable construct, thereby forming two interlocking loops outside of the tissue; and 
 tightening the two interlocking loops by pulling on a free end of the first tensionable construct and the free end of the second tensionable construct. 
 
     
     
       2. The method of  claim 1 , wherein the free ends of the first and second tensionable constructs are pulled sequentially to tighten the two interlocking loops. 
     
     
       3. The method of  claim 1 , further comprising the step of securing the free ends of the first tensionable and second tensionable constructs in bone with third and fourth fixation devices, respectively. 
     
     
       4. The method of  claim 3 , further comprising the steps of:
 arranging the third and fourth fixation devices in a lateral row; and 
 coupling the free ends of the first tensionable and second tensionable constructs to the third and fourth fixation devices to form a bridge. 
 
     
     
       5. The method of  claim 1 , further comprising the steps of:
 prethreading distal eyelets of the first and second fixation devices with first and second flexible materials, respectively, each of the first and second flexible materials having first and second limbs; and 
 passing the first and second limbs of the first and second flexible materials through the tissue proximal to the first tensionable and second tensionable constructs, respectively. 
 
     
     
       6. The method of  claim 5 , wherein the step of prethreading the distal eyelets of the first and second fixation devices with first and second flexible materials includes threading the first and second flexible materials through eyelets of the first and second fixation devices, respectively. 
     
     
       7. The method of  claim 5 , wherein the two interlocking loops are tightened after passing the first and second limbs of the first and second flexible materials through the tissue. 
     
     
       8. The method of  claim 7 , further comprising the step of securing the first and second ends of the first and second flexible material to bone with third and fourth fixation devices. 
     
     
       9. The method of  claim 8 , further comprising the steps of:
 arranging the third and fourth fixation devices in a lateral row; and 
 coupling the first limb of the first flexible material and the first limb of the second flexible material to the third fixation device and coupling the second limb of the first flexible material and the second limb of the second flexible material to the fourth fixation device to form a bridge. 
 
     
     
       10. The method of  claim 1 , further comprising the step of passing the first tensionable and second tensionable constructs through a cannula after passing the first tensionable and second tensionable constructs through the tissue to facilitate management of the constructs outside of the tissue. 
     
     
       11. A method of knotless tissue repair, comprising the steps of:
 providing a first fixation device with a first tensionable construct that has a tensionable loop; 
 providing a second fixation device with a second tensionable construct; 
 anchoring the first and second fixation devices in bone such that the first and second fixation devices are arranged in a medial row; 
 passing the first tensionable construct of the first fixation device and the second tensionable construct of the second fixation device through tissue; 
 threading a free end of a flexible strand of the second tensionable construct through the tensionable loop of the first tensionable construct and then subsequently threading the free end of the second tensionable construct through an eyelet of a passing device coupled with the flexible strand of the second tensionable construct; 
 pulling on a tail end of the passing device opposite the eyelet thereof to thread the free end of the flexible strand of the second tensionable construct through a splice in the second tensionable construct, thereby forming two interlocking loops outside of the tissue; and 
 passing the first tensionable and second tensionable constructs through a cannula after passing the first tensionable and second tensionable constructs through the tissue to facilitate management of the constructs outside of the tissue.